When I tell people that my youngest son was born at home, I usually get one of two reactions: either there is a sudden flash of enthusiasm, or there is a sudden flare of horror. For many people, it's as if I'd said, "I gave birth in the middle of an eight-lane freeway" or, "I gave birth hanging by my knees from a hot-air balloon in flight." In their view home birth is the bailiwick of hippies seeking an Experience-with-a-capital-E at the expense of their child's safety.
On the last day of May I woke up at three in the morning, unable to sleep through the contractions any longer. I prayed the rosary in the quiet house, girding up for the day ahead.
If I say to skeptics that the research doesn't support the idea of home birth as dangerous, that planned assisted home birth is as safe for low-risk women as hospital birth -- it often just doesn't compute. Usually they assume that I'm quoting voodoo science. Even after I sent my mother a list of references on home birth safety -- references of the British Medical Journal sort -- she said, "I know you think it's as safe as hospital birth." When I asked her what she found objectionable in the studies cited, she said, "I think you should go to the hospital." Other people, less polite than my mother, have said bluntly, "You can't possibly be right."
When the boys woke up, my mother took them out to my in-laws' house for the day. I kissed them goodbye knowing that if all went well I would be the one to tuck them in that night. I called my friend Mrs. Organized and the doctor to tell them both I thought I'd have the baby around dinnertime.
Here are the facts: approximately as many problems arise in hospitals as are solved in hospitals. Some of those problems are iatrogenic, caused by hospital staff who may not have the freedom or the philosophical orientation to let the birth process unfold naturally; some problems occur spontaneously when you take a woman doing the hardest work of her life and put her in an alien place with strangers coming and going and demanding that she sign consent forms mid-contraction. Home birth presents a slightly different set of risks, and you might lose a baby at home who could have made it in the hospital. But the flip side of that truth is never stated: some hospital births result in injuries or deaths that could have been avoided at home.
I spent part of the morning getting ready. Pausing with the contractions, I laundered a load of towels. I spread a shower curtain on the bed and covered it with layers of newspaper and an old sheet. M and I started to do the crossword puzzle together, but the Times Friday puzzle was a little too complicated for me at that point. In the late morning the doctor stopped by on his way to the office. "I think I'm at about three cm," I said. He concurred. "See you later."
Anthropologist Robbie Davis-Floyd has found that women give birth in a way that reflects the values of their culture. In a culture that prizes technology, then, it makes sense that birth would become a technological event. There's a problem with making techno-birth the norm, though: while birth interventions can be lifesaving, their routine use is unjustified. Continuous fetal monitoring, for instance, does not lead to healthier babies. In most cases, babies delivered surgically aren't better off than babies delivered vaginally. If you can find valid studies showing worse outcomes for planned home births with trained attendants using a reasonable standard of care, I'll -- I'll eat my next placenta. (Kidding! I'm only joking, folks.)
Mrs. O came in the mid-afternoon and held my hand while I labored in the bathtub. The doctor came back and said, "Whenever you're ready, can you get out of the tub for a few minutes so I can examine you?" When I moved to the bed I told him, "I think I'm at about six cm." "A very generous six -- almost seven," he answered. I was elated.
This is supposed to be the era of evidence-based medicine, but the resistance to this particular set of data is considerable. It seems to me that in this fearsomely litigious country with its skyrocketing medical costs, an option which is cheaper than hospital birth with no reduction in safety -- especially an option where patient satisfaction is through the roof -- would be a winner all around. But the misperception that home birthers are willfully imperiling their babies persists. I imagine a Temple of Technology, or a Church of the Divine Motherboard, in which votaries lay their oblations before the altar in hopes of finding a way to cut out the risk and pain associated with birth. The servos whir and the screen flickers and up comes the message -- 404: Not found. And some of us say, "Hm. Why are we sitting in this uncomfortable pew again?"
Soon I needed to get out of the tub so I could move more freely. I paced. I groaned. I swayed on Mrs. O's birth ball. The sensations were huge, but not exactly painful. The doctor rocked in my nursing chair, reading a family practice journal. "Careful not to overbreathe," he said mildly at one point. Soon he checked my dilatation one last time. "Just a little rim of cervix left," he said.
Today's home birth is not your grandma's home birth. Home birth attendants carry equipment and medications that allow them to respond effectively to common difficulties. The first few steps for halting a hemorrhage or resuscitating a baby who is slow to breathe can happen as easily at home as in the hospital, and most of the time those first steps are all that's needed. If you do need additional resources at any point, you can transfer to the hospital. It's worth noting that most transfers from home to hospital are non-emergency situations. Home birth attendants say that most problems arise slowly, allowing ample time for good decision-making about the safest way to continue.
After three more contractions I started pushing. Now I hate pushing. If I could, I would dilate to fifteen and skip pushing altogether. God, however, did not seek my input when he was designing the birth process. My babies have huge heads, and I appear to have an average-sized pelvis. They fit, but it's a tight squeeze and the squeezing is no fun. Some women prefer pushing to transition; I find it the most difficult part of the process. At this stage of Joe's birth I was being hammered by enormous contractions, with hardly a minute to rest in between. When I opened my eyes, the room spun.
Just in case we ran into complications, I pre-registered at the hospital and took a tour with my husband. The nurse proudly showed us how a panel in the ceiling opened to let a huge suspended light buzz down into the room, like a SMERSH laser cannon aimed at the laboring woman's perineum. "James Bond gives birth," I muttered to M. Back at home I tried to draft a birth plan in case we ended up at the hospital, but all I really wanted it to say was "Please leave me alone and let me have my baby."
Even with the colossal contractions, Joe's heartrate was just fine and I was still cracking jokes (bad ones, but hey). I told my husband, "Next time, you do the pushing. I'll do the puking; I'll do the pregnancy. But you have to push, okay?" The doctor chimed in: "If men had to go through childbirth, the species would have died out long ago." Mrs. O had been watching me struggle, and she said quietly, "You know, Jamie, sometimes it helps if you tuck your chin."
I didn't opt for home birth because I am a Luddite or because I am phobic about hospitals. I used to work happily in a hospital; I love my broadband connection. But I was intrigued by the way women talked about their home births. In a world where delivering a baby is usually either terrifying or comic, they were talking about birth as profound.
With the next push, I tucked my chin. Suddenly, there was a baby sliding out of my body -- my baby, the baby I had waited so long to see. Joe was born in the caul. I wish I could tell you what it was like in that moment when the doctor slit the membrane and I saw his precious face for the first time. I wish I had words for that moment when I first held him, slippery with amniotic fluid, crying and wriggling and beautifully alive.
When I talk about my home birth I wish I had never used the word joy before, because then I would have a word for what it was like. Of course the aftermath of a healthy birth is always joyful, but with my home birth there was joy in the process, joy in the laboring. It brings to mind a word I use shyly because it is so far from the way most women talk about birth: it was a day of glory, refulgent glory.
When we lived in the UK, I used to go to a playgroup in an upscale neighborhood. One woman came back after having a new baby, and they asked her how the birth went. "Oh, let's face it," she snorted (you have to imagine the upper-crust accent), "childbirth is disgusting."
"Disgusting" is not the word that comes to my mind when I think of Joe's birth. It was messy, sure -- there was blood and sweat and meconium and amniotic fluid in abundance. But all of that was cleaned up in minutes, absorbed by newspapers and rolled up in the shower curtain I had spread on the living room floor. Joe and I hopped in bed and he nursed for the first time, wide-eyed and eager. While he nursed all of us sat in the bedroom and laughed and talked and told stories. "This was very civilized," said my husband (who had initially been quite skeptical about home birth). "People should do this more often."
Joe's birth, that first big letting-go in our relationship, has become a metaphor for me. Yes, motherhood can be messy and painful. But here's what you do when you birth a baby: you listen patiently for your child to tell you it's time, you open the door even when it hurts, and then you welcome him gladly to a new place. That's what I aim to do for my children for as long as they need me to do it. And in the listening, in the opening, in the welcoming -- there is tremendous joy.
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Home birth is a hot topic, and I admit freely that I have not read the primary literature but have relied on abstracts and commentaries in making my own decisions and in writing this post. Some home birth advocates cite studies that show lower complication rates in the home birth population; it is my understanding that these findings can't always be duplicated, and that "as safe as" is more accurate than "safer than" when comparing home and hospital birth. Jump right in and comment if you have a different point of view.
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